By Silvio Aladjem MD
Not too long time ago, the daughter of a friend of mine, who is planning to start a family, asked me a reasonable question: how to choose an obstetrician when she got pregnant? The more I thought about it, the more I believed this is a question that many women may ask themselves. I thought I would share my thoughts about the subject with you.
There is more to this question than meets the eye. There are a number of professionals who take care of pregnant women: midwives, family physicians, obstetricians and specialists in high risk pregnancies.
Should you wish to deliver at home, your choices are limited. Physicians, be this family physicians or obstetricians, do not, as a rule, attend home deliveries. Neither do all midwives. Therefore, you will have to find a midwife willing to go along with you. In so doing, you need to make sure that the midwife is certified (Certified Nurse Midwife-CNM) and that she has an obstetrician working with her willing to take over care in case of a problem. Home deliveries should never be considered for multiple pregnancies (twins, triplets, or so) or if a medical problem with the mother (diabetes high blood pressure and so on) is already present. There is still a heated debate as to whether home delivery is safe or not. Make sure you are well and realistically informed. The “it will never happen to me” philosophy is a dangerous one. If it happens to you it’s 100% even if that particular complication only happens in 5% of patients.
If you wish to be delivered by a midwife (CNM) in a hospital, that’s fine as long as an obstetrician is available for consultation, in case of need.
Some family physicians take care of pregnant women. However, not all will deliver you. When that is the case, it means that at the time of delivery you will have someone else that you never met before and who may not be very happy about the referral. Most women don’t like that arrangement so, again, do your homework and ask questions.
If you want an obstetrician to take care of you, there are certain criteria that you need to consider. Just because he/she delivered your best friend, doesn’t mean it’s a good choice for you. Make sure that the obstetrician is Board Certified or Board Eligible. Make sure that you talk to him/her about what your preferences are in terms of delivery: free of pain or free of medication, how you feel about being on your back for the duration of labor, as opposed to walking around, hot tub delivery, and a host of other issues that are important to you. Not everybody is willing to comply with your wishes, even if there is no reason not to.
Last but not least, do you already have some medical problems (high blood pressure, diabetes, or other medical problems) or have you had problems in a prior pregnancy, which may have a bearing on the current pregnancy.
In such circumstances it is advisable you consult a Maternal Fetal Medicine (MFM) Specialist. These are obstetricians with special training in high risk pregnancies, which you would qualify for.
Where you deliver is just as important as your choice of who is going to deliver you. If you had any prior complications, it is advisable to deliver in a hospital that can provide Neonatal Intensive Care to the newborn. Not all hospitals have such a service. The last thing you want is for you to deliver in your hometown hospital and as soon as you deliver they have to transfer the newborn to another hospital that can provide intensive care.
Most people never think about all these issues. A baby is a baby, and women have delivered babies since time immemorial. I remember one patient that told me: my mother never had prenatal care and delivered 7 babies at home, and never had a problem. Good for her mother, but with that mentality, why do you drive a car when a horse and buggy will do?
Most people never think about potential problems. They happen, more often than you think. Putting yourself, and your baby, in harms way, when today you do not have to, should never be an option. I grant you that you can do whatever you want for yourself, but when that decision potentially could harm the baby, it is not acceptable. Actually, I think it would be child abuse.
Pregnancy should be a joyous time, with unique emotions and expectations. But the top priority, in terms of expectations, is that you and your baby should be well. While getting pregnant itself may not have been planned, and most aren’t except in broad terms of wanting to have children, once pregnant, its course can be influenced by your decisions. Who is going to deliver your baby is one of those important decisions that you will have to make.
You will have to make many other decisions as you go along, some of which you never thought you will ever have to make. While we can’t ever anticipate how the pregnancy is going to evolve, most of them are perfectly normal. We can make them even better by making informed decisions.
About the Author:
SILVIO ALADJEM MD, an obstetrician/gynecologist and Maternal Fetal Medicine (high risk obstetrics) specialist, is Professor Emeritus in obstetrics and gynecology at Michigan State University, College of Human Medicine, in Lansing, MI. He is the author of “10,000 babies: my life in the delivery room” now available on Amazon, Barnes and Noble and other book stores. Dr. Aladjem published extensively in Scientific Medical Journals and wrote several textbooks in the specialty. He can be reached through his website, www.drsilvio.com
You can read more of Dr. Aladjem’s posts on Imperfect Women by clicking here. Dr Aladjem also answers questions of medical interest related to pregnancy in a monthly post here at Imperfect Women. You can read more details about this feature and ask a question by filling out the form here.
I never really thought about it when I got pregnant – I just went to the OB/GYN that I had been seeing for regular checkups prior to that. It was kind of a no-brainer.
I chose the Dr. for my first child, based on the hospital we wanted to deliver at. Then one day, I needed a new Dr. because mine was moving (thanks for the notice). I chose the first Dr. that I heard & who took our insurance. He was amazing! Then our insurance changed & I had to switch yet again, but before my 2nd child was born I was able to go back to the Dr. who delivered my 1st. I was considered a new patient again & he wasn’t taking anymore, but he had a partner then so I saw him. Amazing again! For my 3rd, it was a matter of who was in town to deliver since she decided to come early (the 1st Dr. won). But when my regular Dr. started his own practice, I followed him. I totally lucked out every step of the way.
I loved my obstetrician and was so thankful he was the one on call when I had both of my babies.
This is a good question. I had to pick a new doctor when I got pregnant and luckily she was available for the birth!
1It’s always important to choose someone that you trust
I chose the dr that was recommended to me by the infertility doctor. When I met her.. I knew she was the one. She then delivered all 3 of my babies (at different times). Now I think I would make it as if she was on a job interview.
I had my baby at home, hired a midwife – there was no doubt in my mind who was going to deliver my kid – it was ME! LOL
In all seriousness though, I didn’t get a chance to meet either of my doctors before my first were delivered and it made it kind of cold experience, it’s why I did the third one at home (well, one of the reasons).
After I’d chosen my OBGYN with a lot of care, he fell from a tree and broke his leg for almost the duration of my pregnancy, so he was not present at my delivery 🙁
These are great recommendations! I looked at various physicians as well. Doing your homework is key!
I had both of my children in the hospital. It never thought of having a home birth. I trusted my GYN and all went well.
I had all of mine in the hospital at a birth center.
These are all good points. **SIGH** We are trying to have a baby, and now you’ve just given me so much more to think about LOL (But in a good way!)
I never really cared for some reason up until baby #6 then I did research. Which is probably because with #5 I had the WORST OB ever. So with 6 I didnt want that and I actually got an incredible, OB who I really hope to get again since we just discussed having baby #7!! lol.
Good question! WIth my first child, I just used a regular OB/GYN. She was okay. With my second, I was supposed to have a homebirth, but ended up with a midwife in a hospital again. Much better experience, than the first, though.
I interviewed a few of them to see which one I felt most comfortable with. It worked out perfectly.
I had a midwife for babies one and two. I loved it. I did switch to an ob/gyn for the last two babies, but not because I was dissatisfied with the others, the office was just very close to my work and I was comfortable w/the doctor. It’s such a personal choice, but def. one that should be carefully considered.
For my two older daughters, I was blessed that the obstetricians in the Naval Hospital were both amazing. For my third one, a year ago, I chose a midwife and delivered in a hospital. I had a two-page birth plan but the priority was safe baby, safe mom. That comes first!
There are many options to think about when delivering your baby. The obvious would be the regular OB/GYN, but I have a client who is planning to have her baby at home in the water tank with a mid wife. No meds at all. My mom has 9 of us and she has only had one of us in the hospital. We were all born at home with no meds. She even delivered her second child herself because she lived remotely and was home alone. Gosh that would be considered irresponsible in these days. But it is the way it was back then
This can be such a difficult decision for so many to-be parents. I never had a difficult time deciding, I just knew who my doctor would be the second I met him. We have some pretty amazing doctors where I live.
This is great information. I was not happy with the OBGYN I was with when I got pregnant …. just personal reasons, she wasn’t the right fit for me. I switched to a different practice. Then a few months later, one of the doctors of that practice who I was seeing for one of my visits said she was leaving the practice to start her own. I really liked her best of all the ones I’d rotated through so I went with her, so I went through 3 practices during one pregnancy! It really can be a complicated decision!
The ones I saw throughout my pregnancies weren’t even the ones who delivered my babies, so I guess it didn’t matter who I chose 🙂
I always had to have a physician since I had to have c-sections. I so wanted to have a natural delivery wit a midwife but unfortunately for me it couldn’t happen. My best friend in NY had a water birth with a midwife.
Wow I never really thought about this. I guess it is indeed important. I should take this in mind once its my turn.
I really hated my obstrician because She was so hateful! I was in a Very particular moment and She didn’t help me at all!